Provider Demographics
NPI:1043573330
Name:LIGHT, RAE LOUISE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:RAE
Middle Name:LOUISE
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 E BUCKTOOTH RUN RD
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:LITTLE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14755-9753
Mailing Address - Country:US
Mailing Address - Phone:716-945-3981
Mailing Address - Fax:
Practice Address - Street 1:4249 E BUCKTOOTH RUN RD
Practice Address - Street 2:
Practice Address - City:LITTLE VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14755-9753
Practice Address - Country:US
Practice Address - Phone:716-945-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No174400000XOther Service ProvidersSpecialist